What Should the Nurse Do?
1
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Antonio, a twenty-eight-year-old male, seeks treatment at the outpatient mental health clinic due to interpersonal difficulties and ongoing emotional distress. He reports a history of strained relationships, frequent job changes, and a sense of emptiness. Antonio describes intense and unstable emotions, fearing abandonment, and engaging in impulsive behaviors, such as reckless spending and substance use. He reports episodes of anger and difficulty controlling his anger, often resulting in strained relationships. During the assessment, his vital signs are a blood pressure of 120/80 mmHg, heart rate of 90 bpm, respiratory rate of 18 breaths per minute, and temperature of 98.6°F (37°C). Antonio has a history of self-harm, including cutting, and has experienced several brief hospitalizations for suicidal ideation. He reports a history of traumatic experiences during his childhood but has not received consistent mental health treatment.
What immediate actions should be taken during the initial assessment to ensure a thorough understanding of Antonio’s symptoms and their impact on his daily life?
Robert, a thirty-five-year-old male, seeks treatment at the outpatient mental health clinic due to interpersonal difficulties and recurring conflicts at his workplace. He reports feeling misunderstood and isolated. He describes himself as socially anxious and uncomfortable in group settings. He mentions difficulty forming close relationships and often perceives others as untrustworthy. He reports occasional paranoid thoughts about colleagues plotting against him. Robert has a history of avoiding social situations and has experienced chronic feelings of inadequacy. He has never sought mental health treatment before and reports a generally healthy medical history. His vital signs are a blood pressure of 130/82 mmHg, heart rate of 78 bpm, respiratory rate of 16 breaths per minute, and temperature of 98.4°F (36.9°C).
2
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What specific behaviors and statements made by Robert might be indicative of symptoms associated with cluster A personality disorders, especially paranoid personality disorder?
3
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If there are indications of impulsivity or intense emotional reactions in Robert, how might this have impacted him socially?
4
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How will you measure the effectiveness of interventions over time, and what indicators will suggest positive outcomes in terms of Robert’s social functioning and reduction in paranoid thoughts?
Emma, a forty-year-old female, seeks treatment at the outpatient mental health clinic due to chronic difficulties in maintaining stable relationships. She reports intense feelings of emptiness, fear of abandonment, and frequent emotional outbursts. Emma describes patterns of impulsive behavior, including reckless spending and occasional substance use. She expresses a pervasive sense of unworthiness and struggles with self-identity. Emma has a history of interpersonal conflicts and brief hospitalizations related to suicidal ideation. She has engaged in self-harming behaviors, particularly during times of emotional distress. Emma has not received consistent mental health treatment in the past. Her vital signs are a blood pressure of 118/78 mmHg, heart rate of 92 bpm, respiratory rate of 20 breaths per minute, and temperature of 98.7°F (37°C).
5
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What specific behaviors and statements made by Emma might be indicative of symptoms associated with a personality disorder, particularly one that involves fear of abandonment and impulsive behaviors?
6
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What nursing interventions could be implemented to address Emma’s fear of abandonment and impulsive behaviors? How can a nurse foster a therapeutic alliance to support her in developing healthier coping mechanisms?